Anwendungnen in Therapie Simulation, Planung, Navigation

Transkript

1 Anwendungnen in Therapie Simulation, Planung, Navigation 10 Feb /91

2 Interventional Closed Loop Manual Robotic Irradiation 2/91

3 Strahlungsquelle: Moderne Beschleuniger (X-Rays) 3/91

4 Beschleuniger X-Rays e - Target X-Rays 4/91

5 Beschleuniger X-Rays PEV: Idealer Patient + H 2 O 5/91

6 Depth Dose Anwendung von Bestrahlungsfeldern X-Rays 1 x Feld (homogenes) H 2 O MV MV 10 MV MV Depth (cm) 6/91

7 Anwendung von Bestrahlungsfeldern X-Rays mehrere Felder (homogene) 100% H 2 O Dicke / Größe & Energie 7/91

8 Image-Guided Strahlentherapie: On Board Technologie Bildgebungstechnologie integriert im Bestrahlungsgerät 8/91

9 Image-Guided Strahlentehrapie: On Board Technologie und Robotik Cyberknife 9/91

10 Image-Guided Strahlentherapie: On Board Technologie Bestrahlungsgerät integriert im Bildgebungssystem TomoTherapy 10/91

11 Anwendung von Bestrahlungsfeldern Regel #1: Die Anwendung von mehreren Feldern erhöht die Homogenität der Dosisverteilung 11/91

12 Anwendung von Bestrahlungsfeldern Regel #2: Die Anwendung von mehreren Feldern erhöht die Konformität der Dosisverteilung bezüglich PTV Bildgebende Verfahren in der Medizin und medizinische Bildverarbeitung Visualisierung 12 / 106

13 Anwendung von Bestrahlungsfeldern PTV 13/91

14 Anwendung von Bestrahlungsfeldern Regel #3: Die individuelle Anpassung der geometrischen Form der einzelnen Felder erhöht die Konformität der Dosisverteilung bezüglich der Risikorgane & Normalgewebe 14/91

15 Multi Leaf Collimator Bildgebende Verfahren in der Medizin und medizinische Bildverarbeitung Visualisierung 15 / 106

16 Anwendung von Bestrahlungsfeldern PTV MLC 16/91

17 EXOMIO/ProSoma Simulator LINAC Linear Accelerator Virtual Simulator 17/91

18 Beams Set-sp 18/91

19 Oblique Beams & MLCs 19/91

20 Isodose 20/91

21 Isodose 21/91

22 Real-time volume rendering 22/91

23 Collision Detection Patient management Plan parameters panel Collision check (red frame) Beam parameters panel Visualization panel Messages panel 23/91

24 Collision Detection 24/91

25 Linear accelerator models Philips SL-75 Siemens Mevatron Elekta Sli Series Siemens Primus 25/91

26 Collision Detection On Site Simulation 26/91

27 Intraoperative Navigation 27/91

28 Interventional Closed Loop Manual Robotic Irradiation 28/91

29 Protonen/Ionen Bestrahlung 29/91

30 Relative Depth Dose Protonen/Ionen Bestrahlung Protonen/Ionen Energie- Modulation MeV Protons 192 Ir (400 kev) Depth in Water (cm) 30/91

31 Proton Gantry, 8 x 12 m, 200 tn 31/91

32 Gantry, Table & Panels 32/91

33 Gantry, Table & Panels 33/91

34 Before correction 34/91

35 After correction 35/91

36 Automatic matching 36/91

37 Irradiation Positioning 37/91

38 3D Camera In-Situ 38/91

39 3D-camera Registration of Volunteer 39/91

40 Automatic Correction Calculation 40/91

41 Laser 3D-Camera Use the room lasers Angulated additional camera Distance over trigonometry Precision ca. 1 mm Video speed rate 25 fps 41/91

42 Distance & Breathing triggering 42/91

43 Afterloading Brachytherapy 43/91

44 ERT BRT 44/91

45 Beam: 3D Conformal Radiation Therapy (3D CFRT) ERT BRT 1 3 1: Catheter / Needle 3D 3D 45/91

46 Afterloading: Das Prinzip... 46/91

47 Afterloading-Technologie 47/91

48 3D U/S Data Acquisition 48/91

49 Organ Segmentation 49/91

50 Implantation 50/91

51 Dose Calculation 51/91

52 Multi-Variate Optimisation 52/91

53 Dose Evaluation 53/91

54 Magnetic Tracking 54/91

55 Landmarks 55/91

56 Registration 56/91

57 Needle Tracking 57/91

58 Video 58/91

59 Paths Pre-Planning 59/91

60 Application Example 60/91

61 Pre-Operative Scan 61/91

62 Stereotactic Reference System 62/91

63 Intra-Operative Navigation 63/91

64 Flap Insertion 64/91

65 Flap Digitalisation 65/91

66 Blending pellets on CT 66/91

67 Components of the system Mobile system Trolley, containing the hardware Swivel arm, holding the transparent display Support for the cameras - optical tracking system Magnetic tracking system 67/91

68 Transparent display normal TFT display (patent pending) Resolution: 1024 x 768 pixels Frame rate: 75 Hz 68/91

69 Phantom Trials 69/91

70 Display View 70/91

71 Needle implantation 71/91

72 Needle implantation 72/91

73 Needle implantation 73/91

74 Status 74/91

75 OP-room demonstration 75/91

76 Fusion Imaging Virtual Navigator Freehand Navigator

77 Technical principle

78 Registration

79 Synchronized images

80 Side-to-side view

81 Overlay mode

82 Fusion Imaging in der Neurologie ausgewählte Beispielapplikationen

83

84 1:segment vessels in MRI

85 2: acquire 3D U/S in CFD

86 Automatic Registration process

87 Automatic Registration Result

88 Navigated Examination

89 Fusion Imaging Virtual Navigator Freehand Navigator

90 Virtual Navigator Registers patient location (as visible on U/S) with CT/MR/PET Displays live U/S image with corresponding CT/MR/PET slice Blends markers (e.g. target areas) in both modalities Compensates patient movements (head & neck) Displays implantation path on U/S & CT/MR/PET Enables implant planning & multiple implantations Enables post-treatment comparison

91 Marking Target Area

92 Implantation

93 Results 580 patients Lesions treated : 1345 Lesions missed : 26/1345 (< 2%) Complications related to the guidance method : 0 Major complications in ablations performed with fusion imaging : 8/632 ablation sessions

94 T.C. HCC VII cm /09/2010 PRE POST Necrosis : cm 4.6 x 4.0 x 4.2

95 Fusion Imaging Virtual Navigator Freehand Navigator

96 Free-hand implantation

97 General instrument off-plane implantation

98 Breast

99 Targeting

100 Freehand fusion imaging

101 Lung fusion

102 Lung biopsy

103 Initial registration: surface trails 103

104 Craniotomy planning 104

105 Navigating by closed dura 105

106 Navigating by closed dura 106

107 Navigating with stylus 107

108 Re-calibrated after brain shift Removed tumor part 108